71% of citizens support the idea of COVID-19 vaccines to be first administered to individuals who are antibody negative

December 16, 2020, New Delhi: A vaccine is one of the powerful weapons in our armamentarium in the war against the Covid pandemic. Scientists and the industry around the world came together in a highly efficient way to develop a good number of vaccines in a very short period. We should consider this an achievement of humanity. However fast and efficient we are, we will not be able to manufacture enough number of vaccine doses to inoculate the vast majority of the global and national population in a year or two. Hence, we need to prioritise the vaccination process to vulnerable individuals. Those who are recovered from the infection with a positive antibody level are immune from reinfection for a considerable period. More than 99% of the 40 million individuals recovered from the infection, didn't experience any reinfection. Published good quality data is available on the relative protection of the antibody-positive individuals from reinfection, compared to the negative antibody group. Most individuals recovered from the Covid are positive for the antibody, that is sustained and robust for a considerable period. Even those individuals with a negative antibody level are found to have robust cell-mediated immunity. Though it is easy to measure the antibody level, the measurement of cell-mediated immunity is very tedious and not feasible at the community level. However, the measurement of the antibody level, with acceptable accuracy, is within reach of most good quality laboratories.

Several Indian cities have reported high seroprevalence in the community. Though the overall seroprevalence in the country could be ten per cent so far; several metropolitan towns and regions have reported very high rates. As per the Indian Council of Medical Research (ICMR) seroprevalence data, 25% of the Delhi population is antibody positive. A recent study found 27% of the Karnataka population to be seropositive. Plenty of data is available for similar high seroprevalence in other cities. Health care workers and other front line workers are also expected to have high seroprevalence.

After Dr Abdul Ghafur, a leading infection expert based in Chennai suggested on LocalCircles "the existing evidence suggests the antibody response after a COVID-19 infection is reliable and sustained. Due to the inevitable shortages in the supply of COVID-19 vaccines, we must prioritise high-risk groups". "We can streamline the process further if we vaccinate the COVID-19 antibody-negative high-risk individuals first and then the positive antibody individuals.", continued Dr Ghafur. Based on the strong citizen support to Dr Ghafur's suggestion, LocalCircles conducted a survey to understand the collective public opinion. To the question, "To ensure that the most vulnerable get the COVID-19 vaccine first, should the Government as a first step get a COVID-19 antibodies test done and vaccinate only those individuals who do not have COVID-19 antibodies?", local circles received 9,863 responses. Notably, 71% of the citizens, want the Government to administer COVID-19 vaccine first to those who test negative for COVID-19 antibodies, while making the antibody test a precursor to vaccination. Only 15% voted "No".

71% citizens want the Government to administer COVID-19 vaccine first to those who test negative for COVID-19 antibodies; make antibodies test a precursor to vaccine

The Government is likely to prioritise the vaccine such that healthcare and frontline workers, senior citizens and those with co-morbidities get it first followed by the general population. The same approach could be undertaken within these groups. "We can also request those citizens who are antibody-positive to opt-out of being in the priority list and receive their doses once the antibody-negative high-risk individuals have all been vaccinated.", said Dr Ghafur.

Dr Ghafur explained the strategy further. "Antibody testing of all the individuals before vaccination, may not be logistically feasible. Utilising the existing seroprevalence data, we can identify high seroprevalence regions and groups such as health care professionals. If necessary, we can generate additional seroprevalence data. We can conduct prior antibody testing of individuals in these high seroprevalence regions and groups, before deciding on the vaccination. The strategy may not be feasible in regions and groups where the seroprevalence is less than ten per cent." A recently published mathematical modelling by a team of researcehers in United States confirms the usefulness of this strategy. The modelling predicated that preferentially vaccinating seronegative individuals yielded large additional reductions in cumulative incidence and mortality in locations with higher Covid seroprevalence and modest reductions in locations with low seroprevalence.

LocalCircles will be sharing these findings with the key Government stakeholders, so they are aware of the public opinion as they finalise the vaccine administration priorities and framework.

Survey Demographics

9800+ responses were received from citizens located in 203 districts of India. 69% respondents were men while 31% respondents were women. 48% respondents were from tier 1, 29% from tier 2 and 23% respondents were from tier 3, 4 and rural districts. They survey was conducted via LocalCircles platform and all participants are validated citizens who had to be registered with LocalCircles to participate in this survey.